Oral Health Flashcards
1
Q
Teething Symptoms
A
- pain
- mild increase in temp
- irritability
- increased drooling
- loss of appetite
- restlessness
Teething can be stressful and frustrating for parents to identify and ma
2
Q
Teething non- pharmacological treatments
first line treatments
A
- chilled teething rings - should be silicone, avoid liquid filled rings: made of 1 solid piece, should not be frozen
- sugar free teething rusks
- gently rubbing/massaging gums with a cold spoon/ wet gauze
- chilled fruits and veg
- reassure and comfort
- AVOID teething necklaces or beads:
3
Q
Teething Pharmacological treatments
A
- teething gels- not endorsed due to risk of lignocaine toxicity/ lack of evidence of efficiency and the potential for harm
- oral analgesics
4
Q
When teething treatment is appropriate
A
- are we sure this is due to teething
- signs of tooth eruption visible
- non-pharmacological interventions are not adequate
- other causative factors ruled out
- no contradiction in medical history
- no interactions with other medications
- patient is aware of safety concerns
5
Q
Teething Gels
A
often contain choline salicylate or sodium salicylate which are anti-inflammatory agents
lignocaine aka lidocaine: local anaesthetic eg) in SM33 gel
Not appropriate: SM33, seda lotion etc
will the gel have sufficient contact time? swallowed easily, accurate do
6
Q
Teething gel risks
A
Risks may outweigh benefits
- salicylates in under 12s: Reye’s syndrome
- swelling in the brain and liver that can be fatal when salicylates are given when the child is experiencing a viral infection
- risk of salicylate intoxication with repeated use
7
Q
Bonjela
A
choline salicylate
- not for babies younger than 4 months, still use caution for older than
8
Q
Lignocaine risks
A
potential seizures/ cardiac effects
9
Q
Homeopathic teething gels
A
no clinical evidence of efficiency/supporting their use
would not recommend due to potential risks, unless parent/carer is highl
10
Q
paracetamol for teething
A
- analgesic and antipyretic
- appropriate when child is showing discomfort + measurable mild fever( above 37)
- refer if greater than 38 degrees
- for older than 3 months: for 1-3 months on advice from Dr
- when the weigh more than 5 kilograms
- 15mg x child’s weight every 4-6 hours up to 4 times daily
- do not exceed 1g per dose
- provide and locate dose
- use more concentrated products, therefore parents have to give a smaller volume
few precautions: avoid doubling up (on paracetemol products)
11
Q
ibuprofen contraindications/risks
A
contraindications:
- children with bronchospasm, persistant asthma, varicella/chickenpox, known NSAID allergies
- children showing signs of dehydrations, diarrhea/vomiting: higher risk of renal damage
Rare, but can cause GI toxicity, monitor for GI symptoms
make sure to keep fluids up to prevent dehydration and renal damage
works by blocking cyclooxygenase enzymes from producing prostaglandins.
avoid cycling/using both: increases risk for dosing errors/ potential overdoses
12
Q
Teething referral points
A
- generalised mouth pain that is not localised to eruption sites
- severe inflammation or bleeding
- signs of infection: pus or severe redness
- high fever, more than 38
- significant behavioural changes
- symptoms that seem excessive for normal teething
13
Q
Teething analgesic options
A
ibuprofen or paracetemol, avoid cycling/using both: increases risk for dosing errors/ potential overdoses
do not suggest aspirin- especially if they have a recent/current viral illness
14
Q
plaque
A
sticky colourless bacterial biofilm. - soft and easy to brush of in first few days
- if not removed within 3-4 days it turns into tartar, and needs to be removed by a dentist.
- bacteria generates acid from dietary carbohydrates that we consume
- demineralises tooth enamel
- can lead to dental caries (tooth decay) and gingivitis (gum inflammation), as it sits on the gums and irritates it.
It’s important to control plaque through brushing, interdental care and tongue cleaning, could potentially reduce CV disease risk
15
Q
Neutraflour
description, conc, adv effects, contradictions
A
contains 5000ppm fluoride. first: confirm dental/medical practitioner has assessed clinical need and advised patient to use. We do not independently recommend this.
Adverse effects: fluorosis: white spots on teeth
check with referrer if the patient is under 13 years old, or if they are pregnant
use as part of a prevention plan: other fluoride products, dietary changes, improbing salivary flow, improving oral hygiene.
16
Q
Neutraflour directions for use:
A
- apply a pea-sized amount of toothpaste to the head of a soft toothbrush
- brush teeth for at least 2 minutes
- spit out excess, don’t swallow and dont rinse the mouth
- avoid eating or drinking for 30 minutes to increase contact time
- use for a specified duration: return to doctor/dentist every 3-6 months
17
Q
Natural toothpastes
A
- aimed at children/ those with fears about fluoride + SLS
- probiotics
- calendula
- aloe vera
- lack long-term safety and efficacy date
18
Q
Fluoride alternatives
name + efficiency
A
- hydroxyapatite (moo goo- mooth paste)
- 10-15% hydroxyapatite toothpastes have shown comparable efficacy to pastes/gels with 500-12,500 ppm F-
19
Q
Effectiveness of fluoride + arginine
A
- reduced harmful S. mutans and P/ gingivalis
- helped good bacteria thrive
20
Q
Mouthwashes appropriate usages
A
As an occassional adjunct to, not replacement for brushing and flossing. different purposes: preventing caries, freshness, dry mouth, to clean
21
Q
fluoride purpose
A
strengthen enamel, prevent caries
22
Q
essential oils purpose
and examples
A
antimicrobial, cooling + refreshing sensation eg) thymol, eucalyptol, methol and methyl salicylate
23
Q
hydrogen peroxide purpose
A
bleaching agent+ antimicrobial
24
Q
alcohol usage
A
up to 26%, antibacterial and dissolves essential oils
25
benzydamine hydrochloride and/or benzocaine
analgesics + anti-inflammatory
26
Key side effects of mouthwashes
- staining of teeth + soft tissue
- chlorhexadine increases tartar build up
- taste changes
- worsen mucositis or dry mouth
- significant changes to oral microbiome
- alcohol-based mouth wash: significant increased risk for oral cavity cancers and oropharyngeal cancers with long-term users and frequent users
- can impact microbiome balance.
27
When is it appropriate to use mouth washes?
- pre-surgical preparation
- post-surgical or post-scaling- chlorhexadine based: twice daily for 2 weeks
- treatment of an infection
- reduce inflammation
- orthodontic care- for ppl with braces etc
- high caries risk patients- strengthens enamel
- limited manual dexterity
- post radiation/chemotherapy- dry mouth rinses, flouride
28
How to properly use mouthwashes
- use after brushing and flossing
- don’t eat or drink for 30 minutes after use
- use for typically 30-60 seconds
- volume: 15-20mL
- for chlorhexadine washes: use 0.5 to 2 hours after toothpaste as chlorhexadine interacts with fluoride
- short term use only- up to 2 weeks, can build tartar
29
alcohol containing mouthwashes
| Safety considerations
- detrimental effects in concentrations greater that 20%
- potential oral cancer risk with regular and long term use
- risk of accidental ingesting in children. should not be used for children
- interactions with medications, addiction issues
if long-term use is required, choose alcohol free products
monitor for staining + side effects
check for specific contradictions:
- severe gingivitis or mouth ulcers: avoid alcohol
- xerostomia: avoid alcohol= dry mouth
- under 6 yo: avoid fluoride, due to ingestion concerns
- alcohol dependency: avoid alcohol
- allergy: reports of fatal allergic reacttions to chlorhexadine etc
30
gingivitis
| what is it/how is it caused
Excess plaque and tartar build-up between gum and teeth
inflammation of the gums/ swelling of gingiva
bacteria releases enzymes and toxins
inflammation travels downwards: erosion of bone holding the tooth= periodontitis
connection between gum disease and microbiome????
31
Gingevitis Clinical features
- symptoms can be very mild or even painless
- may notice that gums are redder and bleed easily with slight trauma such as brushing/ flossing teeth
- gums start to recede
- halitosis might be present
32
Periodontitis
when plaque is not removed, the inflammation travels downwards, and involves the periodontal ligament and tooth structure.
Pocket forms between tooth + gum, leading to erosion of the tooth and bone over a period of years
main cause of tooth loss in people older than 40 years
33
Drugs that can cause gum overgrowth
| medication induced gingevitis
- phenytoin
- nifedipine
- cyclosporin
34
Drugs that can worsen gingivitis
| medication induced gingivitis
- oral contraceptives: hormonal changes can lead to inflammation
- antideppressants, antihistmamines: reduce saliva which leads to dry mouth and plaque build up
- beta- blockers: gum inflammation
- chemotherapy agents: can damage oral tissues and lead to inflammation
35
Medicines that induce gum-bleeding
| medication induced gingivitis
- blood thinners/ anti-clotting meds
- eg) warfarin and other direct oral anti-coagulants
- NSAIDs including ibuprofen, diclofenac, celecoxib
36
Triggers for referral- Gingevitis
spontaneous gum bleeding with other systems such as fatigue, weakness and signs of systemic illness
may suggest more serious underlying disorders such agranulocytosis and leukaemia
🚩loose teeth or loss of teeth
🚩 if we suspect medicine induced
37
Dental Caries Process
- bacteria digesting sugar and carbohydrates, producing acid as a byproduct
- acid demineralises surface of tooth enamel over time
- erosion creates cavities/holes in tooth and eventually reaches the pulp where nerves and blood vessels are, which is very painful.
38
Treatment for dental caries
analgesia, nyal, oral-eze
39
Nyal Toothache drops
Indication: dental caries
contains: benzocaine, clove oil and phenol
directions: 1-2 drops on cotton pellet to aching tooth for 1 minute, maximum of 4 times daily
40
Simple oral analgesics for dental caries
Paracetemol
For mild to moderate pain
affordable
safe for most people
check for concurrent use of other paracetamol containing products
recommended dose often ignored
perception of safety is a problem
dosage: 1 g q4-6h prn, up to 4 doses in 24 hours
- Ibuprofen
mild to moderate inflammatory pain
avoid in some patients: medical and medication history
dosage: 400 mg tds prn, max of 6 doses daily
- Diclofenac
moderare inflammatory pain
avoid in certain patients
dosage: 50mg for n1st dose then 25-50mg q8h prn
no more than 200mg in 24 hours
- Paracetemol+ Ibuprofen
1 tab tds
40
Oral-eze Dental emergency toothache medication
Indication: dental caries
contains: benzocaine and clove oil
directions: 1-2 drops on cotton pellet, hold on aching tooth for 1 minute, max 4 times daily
41
Dentures care + maintenance
- brushed daily to remove food + plaque and prevent staining
- soak overnight in cleeaning agents
- see dentist regularly for re-alignment and fitting
42
Products available for dentures
- cleaning agents
- polident daily cleanser
- chemical soaks
- h+b denture bath
- special toothbrushes + toothpaste
- wisdom denture brush
- adhesives
- seabond
- holdtite
- re-liners
- cushions
- denpads
- fitty dent
43
Xerostomia common causes
- old age
- radiation therapy
- certain medical conditions:
- diabetes,
- HIV,
- sjogren syndrome,
- oral thrush,
- TB
- medications
- antichlinergics
- antihistamines
- antiemetrics
- antiaxiolytics
- antidepressents
- antidepressants
- antipsychotics
- decongestants
- diuretics
44
Xerostomia symptoms
- constant sore throat
- burning mouth
- problems speaking
- difficulty swallowing
- hoarseness
- dry nasal passage
- dry lips
45
Xerostomia treatment
encourage regular professional dental care
- regular dental cleanings
- fluoride varnishes at each cleaning
46
Xerostomia management strategies
- refer for medication review/adjustment
- consider referral for use of fluoride toothpastes- may need 5000ppm
- sugar-free gum/lozenges
- OTC products
- **saliva stimulants**
Promote natural saliva production, often contain mild acids or flavours to stimulate salivary slands
requires salivary glands to still have some function
Include:
Sugar-free hard candies/lozenges (malic acid)
sugar-free chewing gums- contain various sweeteners eg) aspartame, saccharin and sorbitol which increase saliva production
xylitol containing gum/lollies
reduce cariogenicy of the oral bacteria flora
chewing dried fruit slices such as peaches or nectarines
excess sorbitol + xylitol can lead to GI side effects: flatuence, cramps and diarrhoea
- oral lubricants
- saliva substitutes
- educate on other self-care strategies and oral microbiome
47
Xerostomia Self Care
- Ensure adequate hydration = drink (not sip) adequate amounts of water (not just tea)
- eat chewy food to stimulate saliva flow and chew thouroughly before swallowing
- chew sugarless gum or suck sugarless sweets
- chew celery
- limit caffeine + alcohol intake and avoid cigareetes
- avoid astringent food and drinks such as black tea and coffee
- avoid alcohol-containing mouthwashes
48
Halitosis- Intraoral Causation
Poor oral hygiene
Self-limiting causes:
- mouth breathing or snoring
- odour-causing foods eg) garlic
- smoking and alcoholic beverages
Underlying pathology:
- intraoral infections
- salivary gland hypofunction
- tonsillar pathology
- oral cancer
49
Halitosis- Extraoral Causation
- respiratory infections
- intranasal foreign bodies
- GI issues
- kidney + liver disease
- ketoacidosis- eg) starvation, protein only diet, diabetes
- medications: acid reducers, anticholingics, antidepressants, antifungals, antihistamines, steroids, antipasmodics
- chemotherapeutic agents
- dietary supplements
- organosulfur substances
50
Halitosis interventions
1. mechanical cleaning- tongue cleaners and toothbrushes
2. chewing gums
3. systemic deodorising agents eg) mushroom extract
4. topical agents eg) hinokitiol gel
5. toothpastes- triclosan
6. mouthwash/mouthrinse- chlorhexadine, cetylpyridium
7. tablets
8. a combination of different treatments
51
Halitosis- management
promote oral hygiene + care of microbiome
avoid self-limiting causes
consider medication-review if you suspect it is medication induced
refer if you suspect underlying pathology
OTC product- oral 7 etc
52
Mouth Ulcer causes
- infection
- food hypersensitivities
- trauma
- stress
- nutritional deficiencies
- Vit B12
- Zinc
- Iron
- Medications
- NSAIDs including aspirin
- Cytotoxic drugs
- feverfew- herbal
53
Mouth Ulcers treatments
local analgesics, corticosteroids
54
Kenalog in orabase
- 2-3 times daily after meal
- dry ulcerated area
- press a small dab onto lesion until a thin film develops
- safe in 2nd and 3rd trimester pregnancy and in lactation
| Triamcinolone 0.1%
55
Difflam mouth gel
| ingredient
benzydamine
56
SM33 gel/liquid
| ingredient/s
salicylic acid + lignocaine
57
Mouth Ulcers- referral points
- children- for their first time and otherwise healthy
- duration: longer than 14 days
- painless ulcer
- signs of systemic illness eg) fever
- ulcers are larger than 1 cm in diameter
- ulcers in crops of 10 or more
- if ill fitting dentures are suspected: refer to dentist for refitting
58
Mouth Ulcers- Self Care
- avoid food + drink that can irritate
- suck on ice to relieve pain of mouth ulcers
- nutrition-rich diet with vit B12, folate
- relaxation techniques, addressing stress
- quit smoking
- prevent oral trauma: braces and wax
59
Cold Sore Phases
1. Prodromal Phase
Discomfort, tingling, burning or irritation
may occur in the skin 6-24 hrs before the appearance of lesions
ideally begin treatment in this stage
1. Lesions- blister:
Appear as blisters and vesicles on top of inflamed red, raised skin
1. crusting
Blisters break down to produce a raw area with exudation and crusting by the 4th day after their appearance- itchy and painful
Usually the infection is resolved within 1-2 weeks
60
Cold Sores- differential diagnosis
Oral cancer can appear very similar to cold sores
- cancerous lesions are often painless
- persist for a long time
Impetigo (school sores)
- usually more widespread
- does not necessarily start close to the lips
- patch of inflamed skin that develops into vesicles followed by honey-coloured crust
- common in school aged children
61
Aciclovir
MOA/indication: antiviral, reduces time to healing (by around 24 hours) and reduces pain experienced from the lesion
Dose/directions: Treatment should be started as soon as symptoms are felt and before lesions appear. Apply 5 times a day for 5 days. Safe from 2 years old
ADRs: may cayse transient stinging sensation after application
- topical aciclovir safe in pregnancy and breastfeeding
- duo with hydrocortisone should not be used for uder 12 year olds.
62
Virasolve cold sore cream
- Idoxuridine- antiviral not as effective as aciclovir
- Lignocaine- local anaesthetic- for pain and itching
- benzalkonium chloride (antiseptic to prevent secondary infection
Apply every hour on day 1, then qid on subsequent days until cold sore disappears
avoid in pregnancy and lactation as data is lacking, and avoid in under 12s.
63
Povidone Iodine Cold sore paint and ointment
- reduces incidence of secondary bacterial infections
- apply 4 times daily
- avoid in pregnancy and in babies younger than 6 months old
64
Cold sore patches
hydrocolloid dressings- cover up cold sore wound, promote healing and prevents transmission
65
Oral famciclovir
- for recurrent infections
- 1500mg in adults/ over 18s
- most effective in initiated in prodromal phase
- avoid in pregnancy and breastfeeding, immunocomprimised
- ADRs: headache, fatigue, nausea or diarrhoea
66
Cold Sores- self care
- wash hands after applying treatment
- try not to touch/pick at sore
- do not touch eyes
- do not care cutlery, towels, face flannels, toothbrushes
- avoid kissing
- avoid oral sex- risk of genital herpes
- avoid sun exposure/wind: use 30+ SPF lipbalm
- use lysine 1000mg tds: reduces outbreaks, severity and healing time
67
Cold Sores referral
- babies and young children aged younger than 18 years and topical therapy not suitable
- signs of bacterial skin infection
- systemic symptoms
- lesions that are
- present for more that 14 days or more than 7 days with treatment
- sever or widespread
- not on or around the lips
- occur more that three times a year
- immuno comprimised
- otc treatments have not worked
- occular signs or symptoms
68
conditions that increase the risk of oral thrush
- diabetes
- immuno-comprimised
- xerostomia
- the very young
- and the very old- debilitated elderly patients
- medications:
- recent antibiotic treatment, especially proad spectrum
- inhaled corticosteroids: prevented with use of spacer/rinsing mouth out after use
69
Oral thrush clinical features
creamy-white, soft elevated patches/plaques
- resemble milk curds
- can be wiped off revealling underlying red mucosa
- painful and sore
70
Oral thrush treatment
Nystatin- Nilstat oral drops
- Dose: 1mL qid after food for all ages (safe from birth)
- continue to use for about 2 days after symptoms disappear.
- use 1mL dropper in box
- after feed/meal not before
- apply drops slowly at front of mouth to avoid choking in young babies
- for adults: liquid should be swished around the mouth for as long as possible before swallowing
- can be dropped onto nipple after feed.
- ADR’s: nausea, vomiting, diarrhoea
- safe in pregancy and lactation
- high sugar content
71
Oral thrush referral
🚩Duration is longer than 3 weeks
🚩diabetes
🚩pregnant
🚩immuno-comprimised patients
🚩 recurrent infection
🚩white, painless patches
72
Oral Thrush self care
- clean dentures out
- replace toothbrush
- steralise babies’ dummies, mouth toys and feeding equipment
- where breastfed infant is affected: both mother and child need to be treated
- if oral thrush is present in babies- check for nappy rash and treat both simultaneously
